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Query: UMLS:C0040586 (tracheobronchitis)
 449 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The effects of several neurohumoral agents and serine proteases on glycoconjugate release from hamster tracheal organ cultures were assessed. The beta-adrenergic agonist isoproterenol inhibited glycoconjugate release, and its effect was abolished by the specific beta-blocking agent propranolol. A cholinergic agonist, pilocarpine, marginally increased glycoconjugate release, and its effect was abolished by the antagonist atropine. Human neutrophil elastase and porcine pancreatic trypsin consistently increased glycoconjugate release by 1.8 to 2.8-fold. When the proteases were inactivated, they were no longer effective in stimulating glycoconjugate release. Histologic and electron microscopic analysis of the protease-treated organ cultures revealed no discernible toxic reaction. In addition, organ cultures prelabeled with chromium 51 did not release an increased amount of radioactivity when treated with the proteases. Biochemical analysis of the glycoconjugates released into the culture medium showed them to be of high molecular weight (90% eluted in the void volume of a Sepharose 6B column) and to be resistant to digestion with hyaluronidase and heparinase, properties consistent with mucous glycoproteins. The mechanism of protease-induced glycoconjugate release is unknown. We speculate that stimulation of airway secretory cells by serine proteases of neutrophilic or other inflammatory cell origin may play a role in the increased airway secretion that is characteristic of acute tracheobronchitis.
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PMID:Serine proteases stimulate mucous glycoprotein release from hamster tracheal ring organ culture. 287 41

High-frequency jet ventilation in neonates has been associated with airway damage ranging from focal necrosis to complete airway obstruction with mucus and severe necrotizing tracheobronchitis. However, studies have lacked consistent criteria for assessment, and jet ventilation systems have varied widely. We compared autopsy and histopathologic findings in six neonates who died after prolonged jet ventilatory support with findings in six matched controls who died after receiving conventional ventilatory support. Jet ventilation consisted of a pressure-limited, time-cycled, flow-interrupter-type system. The airways of all patients were assessed by the histopathologic scoring system of Ophoven et al. No differences were observed between neonates who received jet ventilation or conventional ventilation. We believe that the risk of airway damage should not preclude the use of jet ventilation, although further monitoring is imperative.
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PMID:Comparison of airway pathologic lesions after high-frequency jet or conventional ventilation. 291 97

An edited summary of an Interdepartmental Conference arranged by the Department of Medicine of the UCLA School of Medicine, Los Angeles. The Director of Conferences is William M. Pardridge, MD, Professor of Medicine. Several specialists have recently recognized that gastrointestinal reflux causes complications resulting in significant disease. It causes discomfort, indigestion, esophagitis, Barrett's esophagus, and carcinoma of the esophagus. Pediatricians attribute many early pulmonary problems, and even some sudden deaths in infants, to the reflux of gastric contents. Otolaryngologists now recognize that many cases of nonbacterial, nonspecific pharyngitis and laryngitis are due to the reflux of gastrc acid secretions. Contact granuloma and cancer of the larynx may, in some instances, be secondary to nocturnal reflux. Thoracic surgeons and pulmonologists believe chronic tracheobronchitis and some cases of pulmonary disease are attributable to recurrent bathing of the respiratory epithelium by aspirated gastric contents. An awareness of the many complications of gastrointestinal reflux should lead to a multidisciplined attack on the factors responsible for these diseases.
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PMID:Complications of gastroesophageal reflux. 304 98

The increasing number of beta-lactam antibiotic-resistant infections has led to the development of an alternative treatment: the combination of a beta-lactam antibiotic with an irreversible, suicide-type, beta-lactamase inhibitor. Such a combination, sulbactam/ampicillin, was used in clinical trials at 4 European and 1 American centres to treat severely ill patients with lower respiratory tract infections including bronchiectasis, pneumonia and purulent tracheobronchitis. The sulbactam/ampicillin combination was assessed for safety, efficacy and tolerance in a total of 91 patients. Investigators from all 5 centres reported satisfactory bacteriological and clinical results. The combination agent either cured or improved the condition of virtually all patients who were evaluated. The few side effects reported mainly involved pain at the injection site. A review of these studies indicates that therapy with sulbactam/ampicillin effectively treats lower respiratory tract infections in severely ill patients without causing serious adverse reactions.
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PMID:Sulbactam/ampicillin in the treatment of lower respiratory infections. 306 54

Branhamella catarrhalis, a normal commensal of the oropharynx, is increasingly recognized as an important cause of bronchitis and bacterial pneumonia. Six patients with B. catarrhalis pneumonia documented by transtracheal aspirate or blood culture were studied, and 429 previously reported cases of B. catarrhalis bronchitis and pneumonia were reviewed. The mean age of patients with B. catarrhalis infection was 64.8 years, and preexisting chronic obstructive pulmonary disease was common. The typical clinical picture was that of purulent tracheobronchitis; patients with pneumonia were not severely ill and differed from those with bronchitis mainly by the presence of patchy lower-lobe infiltrates on chest roentgenogram. Fifty-three percent of reported strains produced beta-lactamase. Thirty-nine percent of the cultures were mixed, predominantly with Haemophilus influenzae and Streptococcus pneumoniae. The microbiologic, immunologic, and clinical features of B. catarrhalis infection, as well as the antimicrobial susceptibilities of this organism, were reviewed. The reasons for the lack of recognition of this common pathogen and possible solutions were considered.
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PMID:Branhamella catarrhalis respiratory infections. 312 1

The tracheal and bronchial lesions observed are described in seven patients, presenting with respiratory distress syndrome and receiving both conventional and high frequency jet ventilation for various periods. The histological findings are related to the duration of the exposure as well as the number of pulsations administered to the tracheobronchial tree. Severe damage to the mucosa leading to acute tracheobronchitis, hyperplasia and hypersecretion of the mucosal glands may explain some of the clinical symptoms observed, especially the upper respiratory obstruction. Care should be taken to limit these changes which may lead to various degrees of stenosis in survivors receiving this mode of therapy.
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PMID:Necrotizing tracheobronchitis: a complication of high frequency jet ventilation. 313 63

Neonates with necrotizing tracheobronchitis present a diverse clinical spectrum from asymptomatic disease to severe airway obstruction. A retrospective clinicopathologic study of 206 neonatal autopsy reports spanning a three-year period yielded 122 cases of necrotizing tracheobronchitis with an incidence of 59%. All study patients received treatment prior to the development of high-frequency ventilator jet, oscillator, or interruption. The site and submucosal depth of airway involvement was variable. The most commonly affected anatomic site was the middle or thoracic trachea (56%). The common cause identified was severe ischemia to the airway mucosa and submucosa, occurring with profound birth asphyxia and/or shock. The presence of ischemia supports the concept that decreased tracheoperfusion may be an important factor in the development of tracheobronchial abnormalities.
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PMID:Necrotizing tracheobronchitis. An ischemic lesion. 281 48

Necrotizing tracheobronchitis has recently been described as a complication of mechanical ventilation of newborns with respiratory failure. Despite the use of bronchoscopy, 45% of the reported patients to date have died. In this study, we report the use of extracorporeal membrane oxygenation (ECMO) to stabilize two patients with necrotizing tracheobronchitis. While supported by bypass, both patients underwent prolonged bronchoscopies with removal of extensive amounts of tracheal debris. ECMO provided efficient oxygenation in the face of near total airway occlusion, and permitted far more extensive bronchoscopic debridement and lavage than would have been possible if the lungs were required for oxygenation. In addition, ECMO provided a period of lung "rest" during which ventilator settings were reduced, thus minimizing further barotrauma and allowing for lung and airway healing. Both patients recovered without significant respiratory sequelae. ECMO and bronchoscopy are effective forms of therapy for patients with life-threatening necrotizing tracheobronchitis when conventional modalities of treatment have failed.
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PMID:Treatment of neonatal necrotizing tracheobronchitis with extracorporeal membrane oxygenation and bronchoscopy. 318 90

To identify tracheobronchial abnormalities associated with assisted ventilation, 40 infants with respiratory distress syndrome randomized to receive either short-term (48 hours) conventional or high-frequency jet ventilation were studied. Flexible fiberoptic bronchoscopy (n = 13) was performed and/or clinical and radiographic assessments were used to evaluate for laryngeal, tracheal, and bronchial lesions. There was no bronchoscopic evidence of necrotizing tracheobronchitis after either high-frequency jet ventilation (n = 8) or conventional ventilation (n = 5). Laryngotracheomalacia and nodular vocal cords were the most common abnormalities noted, and they occurred with equal frequency in both groups. Study infants who were not bronchoscoped had no clinical or radiographic evidence of tracheal or mainstem bronchial obstruction. One patient did have microscopic evidence of necrotizing tracheobronchitis at autopsy, however. It is concluded that short-term treatment of respiratory distress syndrome with high-frequency jet ventilation may be performed without undue risk of tracheobronchial injury.
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PMID:Bronchoscopic findings in infants treated with high-frequency jet ventilation versus conventional ventilation. 318 79

Laryngotracheobronchial lesions were carefully documented in 26 neonatal autopsies and were classified into two main types. Type I lesions were focal desquamative or ulcerative, asynchronous, and variable in severity involving areas exposed to contact with endotracheal tube or suction catheter. These lesions are most likely due to trauma of artificial ventilation. Type II lesions were diffuse, necrotizing, more synchronous and uniform in severity involving tissues distal to the endotracheal tube and extending to second or third generation bronchi. The early or mild type II lesions consisted of coagulative necrosis of epithelial cells and mucosal oedema. The late or severe type II lesions showed features similar to those of necrotizing tracheobronchitis described by Metley et al. All the cases with type II lesions had been ventilated with 100 per cent oxygen continuously for at least 3 h during life. The use of pure oxygen may be an important factor leading to necrotizing tracheobronchitis.
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PMID:The histopathology of the upper airway in the neonate following mechanical ventilation. 320 50


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